Correlation of Relative Value Units With Surgical Complexity and Physician Workload in Urology

Gan, Zoe S.; Wood, Case M.; Hayon, Solomon; Deal, Allison M.; Smith, Angela; Tan, Hung‐Jui; Pruthi, Raj S.

doi:10.1016/j.urology.2019.12.044

Cited by 23 publications

(32 citation statements)

References 15 publications

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“…This finding is consistent with one prior study of orthopedic trauma procedures showing that reimbursement is not commensurate with risk, 9 although some studies from other surgical subspecialties have mixed findings regarding this correlation. 22,23 When comparing procedures performed at various anatomic locations, we identified several significant trends. Primarily, knee and arthroscopic procedures were found to have significantly higher reimbursement than the general pool of orthopedic sports procedures.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Lastly, on the basis of prior studies of this topic, complication rates were assumed to relate, at least somewhat, to a higher case complexity and physician stress level. 5 , 22 , 23 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Current Relative Value Unit Scale Does Not Appropriately Compensate for Longer Orthopedic Sports Surgeries

Simcox

Kreinces²,

Tarazona³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To assess whether reimbursement for orthopaedic sports procedures adequately compensates for operative time and surgical complexity. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all orthopedic sports medicine procedures performed greater than 150 times from 2016 to 2018 with regard to operative time, preoperative risk factors, morbidity, and mortality data. Physician work relative value units (wRVU) data were obtained from the 2020 Centers for Medicare & Medicaid Services (CMS) fee schedule. The primary outcome was wRVU per minute operative time (wRVU/min). Linear regressions were used to assess wRVU, operative time, and wRVU/min. Results A total of 42 CPT codes, including 84,966 cases, were stratified into the top and bottom 50%, according to mean operative time, complications, mortality, reoperations, and readmissions. Mean wRVU/min was significantly lower for longer procedures (.153 vs .187; P = .02), and comparable with regard to ASA score, complications, mortality, readmissions, and reoperations. Arthroscopy reimbursed more (.187 vs .148 wRVU/min; P = .008), with lower complications (1.5 vs 2.6%; P = .115) and operative time (56.1 vs 82.8 min; P = .001) compared to open. Multivariate linear regression revealed that after adjusting for complication rate, there was a decrease of .054 wRVU/h ( P = .026) and $116.90/hour less for every additional hour of operative time. Conclusion The current 2020 RVU scale does not fairly compensate sports procedures with longer operative times. When examining the hourly reimbursement rates for the most commonly performed sports procedures, there is a significant trend toward lower reimbursement for longer procedures even after accounting for complication rates. Furthermore, procedures of the knee reimbursed at higher rates relative to the general pool of sports procedures and open procedures are compensated at a lower rate compared to arthroscopic procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Current Relative Value Unit Scale Does Not Appropriately Compensate for Longer Orthopedic Sports Surgeries

Simcox

Kreinces²,

Tarazona³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

View full text Add to dashboard Cite

show abstract

“…The study conducted by Douglas Orr et al shows that RVU cannot reflect the complexity of any procedures, or surgeries with long followup by the surgeon, which may be needed in orthopedics (2). Another study in urology showed that the relative values in this specialty do not reflect the complexity and condition of the patient well and need to be reconsidered (28).…”

Section: Discussionmentioning

confidence: 99%

Challenges of the Relative Value Unit Experience in Iran: A Qualitative Study

Forootan¹,

Hajebrahimi²,

Najafi³

et al. 2021

PJMHS

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Background: The Relative Value Unit (RVU) is a value scale and plays a key role in the physician reimbursement system. The health sector has faced challenges such as providers’ dissatisfaction, income disparities, and reduced service quality which is said to be due to improper RVUs. Always there are debates about it. This study aims to identify the challenges of the RVU experience in Iran from the perspective of the service providers, payers and, policymakers. Methods: This qualitative study was conducted in 2020. Data were collected from November 2019 to February 2020. Thirty experts participated in the study and were categorized into four groups: insurance organizations’ managers, surgeons, health economists, and health policymakers. Focus Group Discussions and semi-structured interviews were held to collect data. Content analysis was conducted to analyze data. Results: According to the expert, the challenges of RVU in Iran are classified into five scopes. Financial, payment, macro-organization, regulation, and persuasion scope. Each scope’s result was categorized into main themes and relevant sub-themes. Conclusions: The RVU has an important impact on the health system, provider behavior, and even patients. Paying attention to required infrastructures, decision- makers’ conflict of interests, decrease the Ministry of Health and Medical Education’s authority, and expanding the active role of involved organizations to increase their commitment to the successful implantation of RVU is necessary. Keywords: Relative Value Unit, Challenge, Expert opinion, Qualitative study, Iran.

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“…The wRVU is now not only used as a reimbursement model but is also known as a criterion to measure a physician's performance and productivity (6). Although RVUs are reviewed by RUC based on receiving suggestions and criticisms from physicians annually, there are still criticisms of RVUs in surgery (7). Previous research showed that the RVU-based payment system did not accurately represent the surgeon's work.…”

Section: Introductionmentioning

confidence: 99%

Development of a Local Model for Measuring the Work of Surgeons

Forootan

Hajebrahimi

Janati

et al. 2021

Preprint

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Background: The relative value unit is the main method of calculating physician reimbursements and a tool for measuring the work of surgeons. Existing evidence shows that work RVU does not accurately represent the surgeon's work. Therefore, the current study attempts to develop a local model to measure surgeons' work.Methods: This study was conducted in two main phases of determining the metrics and model development using quantitative and qualitative approaches from December 2019 to April 2021.The Literature review, focused group discussions, and interviews were used to collect data. Content analysis and Exploratory Data Analysis techniques were applied to analyze data.Results: The findings demonstrated that patient's conditions (age, severity of disease at referring time, and comorbidities), disease specifications (time, complexity, physical effort, and risk), and provider characteristic (surgeon’s willingness, imposed stress, and surgeon’s skill) were important by 17, 51, and 32%, respectively, in determining surgeons' work. Conclusions: Determining a fixed value for each procedure does not accurately estimate the amount of required surgeon’s work for any procedure. Many factors, such as the patient's condition, surgeon's characteristics, and the disease specification affect surgeons' work in the operation room. Proper measurement of the surgeon's work is an important step towards establishing equity in payment in the health system.

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Correlation of Relative Value Units With Surgical Complexity and Physician Workload in Urology

Cited by 23 publications

References 15 publications

Current Relative Value Unit Scale Does Not Appropriately Compensate for Longer Orthopedic Sports Surgeries

Current Relative Value Unit Scale Does Not Appropriately Compensate for Longer Orthopedic Sports Surgeries

Challenges of the Relative Value Unit Experience in Iran: A Qualitative Study

Development of a Local Model for Measuring the Work of Surgeons

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